Study: White, Employed Can't Pay Hospital Bills

TALLAHASSEE — Fifty percent of the people who cannot pay their hospital bills in Florida are below the poverty level, and most of them are young, white adults who are employed.

At least that's the profile of Florida's medically indigent painted by a $150,000 study conducted by the University of Florida in conjunction with the Hospital Cost Containment Board.

The study, required by the 1984 Legislature, was discussed Tuesday at the House Medical Regulation and Sunset subcommittee. It will be an important tool for lawmakers who are trying to develop a health-care delivery system for the poor as well as a method of compensating hospitals for about $165 million worth of unpaid bills they face every year.

Unpaid hospitals bills are shifted to those who can pay.

While the study reinforced legislative opinions on who's providing the free care and where, the profile of the average person who can't pay a bill surprised lawmakers who believed minorities and the unemployed are the biggest users of uncompensated hospital care.

''This shows we're not just dealing with a minority/welfare problem. It goes way beyond that,'' said Rep. Mike Abrams, D-Miami, who heads the subcommittee.

The study shows the largest chunk of uncompensated care is borne by government and not-for-profit hospitals. Government hospitals handle almost 41 percent of the unpaid cases for a loss of nearly $72 million while the non- profits handle 40 percent of the cases for a loss of $64 million. Investor- owned or for-profit hospitals handle 19 percent of the unpaid cases for a loss of $29 million, the study showed.

The study also confirmed the long-held assumption that a majority of unpaid cases originates in hospital emergency rooms, one of the most expensive treatment options available.

After an overview of the study, the subcommittee began dissecting a bill proposed by Abrams to address the indigent care problem. The bill, which creates a program to provide health care to the medically indigent who are not covered by Medicaid, raised more questions than it answered.

Under the bill, services to the medically indigent would be provided through a contractor or a broker and would resemble a health maintenance organization. To encourage counties to provide care to the poor, the bill provides 60 cents for every 40 cents the county contributes to an indigent program.

Initially the program would be funded by a surplus in the Public Medical Assistance Trust Fund, created in 1984 to expand the Medicaid program. The trust money comes from state revenue and a 1.5 percent tax on hospital revenue. Abram's bill lays the foundation for a broad-based tax once the trust fund surplus is depleted.

Subcommittee members raised a number of concerns with the bill, including the costs of administering the program and the ramifications of the federal government bailing out of the Medicaid program.

They also said the 60-40 match would not encourage counties who are not serving the poor to participate.